this case study describes about Pangastritis with pancreatitis , which details about the treatment, management , diagnosis, patient counselling, pharmacist interventions & discussions are followed in this case . please comment thank u martinsuja369@gmail.com

1. •
• CASE STUDY BASED ON DISEASE
• { Pangastritis with pancreatitis }
PREPARED BY
MARTIN SHAJI
Pharm D

2. • Patient name –Ms. x IP no. –165608
• Admission date- 11-11- 2020
• Discharge date – 26 -11-2020
• Age-48
• Sex-Male
• Department – Gastroenterology
PATIENT DEMOGRAPHY

3. 1. Physical examination: patient conscious and coherent
Vital signs:
Temperature (oF): Afebrile.
Pulse rate (/min): 78beats / min
Respiratory rate : 20 / min
Blood Pressure (mm of Hg):130/90mm of Hg
2. Systems Examination:
CVS: S1, S2 +
RS: NVBS +
CNS : NFND
P/A : , tenderness( upper left side ), wall muscles are rigid ,very few intestinal
sounds , lower abdomen + ve
General Examinations

4. CHIEF COMPLAINTS;
Abdominal pain x 2days Constipation x 1 week , Vomiting 4-5 episodes on 6/2
PAST MEDICAL HISTORY
N/K/C/O- DM/SHT/IHD/Epilepsy/BA
Past case of Hyperthyroidism x 2years
H/O:
Abdominal pain 2 weeks ago, admitted and was diagnosed with small tiny
cystic lesion of liver in CECT.
Past Medication History:
T. Carbimazole 5mg OD
ALLERGY :(food/drug/other)
No known allergies.

5. Personal History:
Takes mixed diet, ash exposure in work x 4yrs, has a family history of
DM
Social Habits:
Alcoholic for 6-8 yrs. monthly 3-4 days, pan chewer

6. LAB INVESTIGATIONS
TEST Report values Normal range
HB 11.3 12– 16 g/dl
TLC 7400 3800– 11000 Cells/mm³
ESR 7/14 0– 29 mm/hr
DC N-61, L-37, E-2 N: 45-75,L: 16-46,E: 0-8
BT/CT 2’00”/4’15” 2-7/8-15 mins
BUN 20 8– 25mg/dl
Cr 0.5 0.5 – 1.1 mg/dl
Na+ 132 135-145 mEq/L
BILI (T) 0.6 0.1 – 1.2 mg/dL
BILI (D) 0.4 <0.3 mg/dL
ALT 21 7- 56 U/L
AST 19 10– 40 U/L
Albumin 2.7 3.5 – 5.5 g/dL
ALPPHOS 99 44– 147 IU/L
T. Protein 6.6 6– 8.3 g/dL
FT4 2.1 0.9 – 1.7 ng/dL

7. Test Report values Normal range
Amylase 200U/L 23-85 U/L
Lipase 210 U/L 0-160 U/L

8. Other investigation:
USG, Peripheral smear, OGD (oesophago-gastro-duodenoscopy) ,
Multislice CT, CT Angiogram, Stool occult blood, ERCP .
Impression: USG – N, CT Angiogram – N, Peripheral smear – Microcytic
Hypochromic type
Multislice CT – Tiny cystic lesion in segment 4b of liver.
Suspicious filling defect noted in SMA (Superior Mesenteric Artery) –
suggested abd. Angiogram – others found to be normal

9. OGD- Pharynx, Vocal cord, Oesophagus – N; Stomach – Fundus, Body,
Antrum, Pylorus – Gastritis; Duodenum – N
ERCP - pancreatitis
Stool Occult Blood- 18/11 – Positive
22/11 - Negative

10. SUBJECTIVE EVALUATION
A 48 years old male patient was consulted with the complaints Abdominal pain x 2days
Constipation x 1 week & Vomiting 4-5 episodes on 6/2.
OBJECTIVE EVALUATION
On Examination, the patient was conscious & coherent. Lab data reveals slight elevation
in direct bilirubin , FT4 and decreased levels of sodium ,albumin , along with a tiny
cystic lesion in the liver, filling defect in SMA, inflammation in stomach ,stool occult
blood and altered levels of amylase and lipase .
ASSESSMENT:
Based on subjective & objective evaluation the physician confirmed it as
Pancreatitis, Pangastritis with anaemia
SOAP NOTES

11. CONFIRMATORY
DIAGNOSIS
{ Pancreatitis, Pangastritis with anaemia }
}

12. DRUG CHART
S.No Drug name Dose ROA Freq. No. ofdays
1 IVF. RL 2 pint IV BD 11, 14, 23-26
2 Inj. Ciprofloxacin 200mg IV BD 11-13
3 Inj. Ranitidine 50 mg IV 1-0-1 11-14, 22
4 Inj. Metronidazole 500mg IV BD 11-13
5 Inj. Ondansetron 1cc IV Stat 11, 23-26
6 T. Serratiopeptidase 10mg P/O TDS 12- 20
7 Inj. Dicyclomine 20mg/2ml IM BD 12 - 18
8 Inj. Pantoprazole 40mg IV 1-0-1 14 - 24
9 Syp. Lactulose 10ml P/O HS 15 – 26
10 T. Dicyclomine 10mg P/O 1-1-1 14 - 22
11 Cap. Bifilac I cap P/O OD 21 - 26
12 T. Acetaminophen 500mg P/O TDS 22
13 T. Lupizyme 1 tab P/O 0-1-0 23 - 26
14 Inj. Tramadol 2CC IM SOS 23, 24

13. Discharge summary :
On 26/11/2020 ,the patient was found to be conscious and coherent
,and relieved from chief complaints such as Abdominal pain
Constipation , Vomiting episodes
, Suspicious filling defect noted in Superior Mesenteric Artery found to
be normalized . On 22 / 11 the stool occult blood also found to be
negative .OGD reveals that the patient is free from gastritis &
pancreatitis. Advised to review after 2 weeks ……………………………
Discharge medication as follows

14. Discharge Medication :
Patient discharged on 27.11.20 with the following drugs
T. Ondansetron 4mg BD
T. Rantac 150mg 1-0-1
Syp. Lactulose 10ml HS
T. Lupizyme 1 tab 0-1-0
The patient was asked to review after 2 weeks.

15. Regarding Medication
1.RANTAC ( Ranitidine)
It is an anti ulcerative agent and should be taken twice a day before food.
2. CYCLOPAM( Dicyclomine)
It is the drug used for several intestinal problems like intestinal bowel syndromes . It help
to reduce the symptoms to stomach the intestinal cramping , it reduces intestinal muscle
spasms thereby the pain induced over the regions of stomach and intestines. Its an
anticholinergic / antispasmodic drug.
3.FLAGYL(Metronidazole)
It is an antibiotic used against certain bacteria and protozoa , used to treat a wide variety of
infections induced by microbes but it wont stand against viruses.
4. ONDAN(Ondansetron)
It is an antiemetic agent used to treat nausea and vomiting caused due to certain
medical conditions. It works by blocking the action of a chemical substance that causes
nausea and vomiting.

16. 5. Syp. Lactulose
Lactulose is a non-absorbable sugar used in the treatment of constipation
6 . Serratiopeptidase
Serratiopeptidase helps relieve pain and swelling associated with post-operative wounds and
inflammatory diseases.
Take it 30 minutes before a meal or as directed by your doctor.
7. Cap .bifilac
Bifilac HP capsule is a combination supplement with Probiotic, Prebiotic & immunobiotic
properties.
8 . Lupizyme
Capsule contains Fungal Diastase and Pepsin as main active ingredients which increase
digestion of body.

17. PHARMACIST INTERVENTIONS
Findings: Major interaction: Tramadol & Ondansetron
Ciprofloxacin & Metronidazole
Assessment:
Tramadol & Ondansetron – concurrent use result in increase risk of
serotonin syndrome
Ciprofloxacin & Metronidazole– concurrent use results in QT prolongation.
Resolution:
Avoid concurrent administration.
Monitoring:
Monitor ECG during the course of therapy.

18. PATIENT COUNSELLING – Regarding Life Style
Modifications
Drink enough water
Avoid eating late nights and close to bed time at least 3hrs
before sleeping
Reduce stress
Quit smoking and avoid too much alcohol
Avoid regular use of pain killer drugs
Avoid taking spicy foods, coffee, milk ,tomatoes ,citrous fruits
and juices .
Start taking probiotic foods ,garlic, coconut water, ginger
water , papaya, foods rich in anti oxidants etc……

19. DISCUSSION
• The pancreas is a large gland behind the stomach and next to the
small intestine.
• Pancreatitis is a disease in which the pancreas becomes inflamed.
Pancreatic damage happens when thedigestive enzymes are activated
before they are released into the small intestine and begin attacking
the pancreas.
There are two forms of pancreatitis: acute and chronic.
• Acute pancreatitis. Acute pancreatitis is a sudden inflammation
that lasts for a short time.
• In severe cases, acute pancreatitis can result

20. • Chronic pancreatitis.
• Chronic pancreatitis is long-lasting inflammation of the pancreas.
It most oftenhappens after an episode of acute pancreatitis.
Heavy alcohol drinking is another big cause. Damage to the
pancreas from heavy alcohol use may not cause symptoms for
many years, but then the person may suddenly develop
severe pancreatitis symptoms.
Symptoms of acute pancreatitis:
• Upper abdominal pain that radiates into the back; it may be
aggravated by eating, especially foods high in fat.
• Swollen and tender abdomen
• Nausea and vomiting
• Fever
• Increased heart rate

21. Symptoms of chronic pancreatitis:
• The symptoms of chronic pancreatitis are similar to those of
acute pancreatitis. Patients frequently feel constant pain in
the upper abdomen that radiates to the back .In some
patients, the pain may be disabling.
Causes
• In most cases, acute pancreatitis is caused by gallstones or
heavy alcohol use. Other causes include
medications, autoimmune disease, infections, trauma,
metabolic disorders, and surgery. In up to 15% of
people with acute pancreatitis, the cause is unknown.
• In about 70% of people, chronic pancreatitis is caused by
long-time alcohol use.

22. Diagnosis:
• Pancreatic function test to find out if the pancreas is making the right amounts of
digestive enzymes
• Glucose tolerance test to measure damage to the cells in the pancreas that make
insulin
• Ultrasound, CT scan, and MRI, which make images of the pancreas so that problems
may be seen
• Biopsy, in which a needle is inserted into the pancreas to remove a small tissue
sample for study
Treatment for acute pancreatitis
• People with acute pancreatitis are typically treated with IV
fluids and pain medications in the hospital.
• An acute attack of pancreatitis caused by gallstones may
require removal of the gallbladder or surgery of the bile duct.
After the gallstones are removed and the inflammation goes away, the pancreas
usually returns to normal.
Treatment for chronic pancreatitis
• Chronic pancreatitis can be difficult to treat. Doctors will try to
relieve the patient's pain and improve the nutrition problems.
Patients are generally given pancreatic enzymes and may needinsulin. A low-fat
diet may also help.

23. pangastritis
• Acute gastritis is a term covering a broad spectrum of
entities that induce inflammatory changes in the
gastric mucosa.
• The inflammation may involve the entire stomach (eg, pangastritis)
or aregion of the stomach(eg, antral gastritis). Acute gastritis
can be broken down into 2 categories: erosive (eg,
superficial
erosions, deep erosions, hemorrhagic erosions)
and nonerosive (generally caused by Helicobacter pylori).
• Symptoms include nausea, vomiting, loss of appetite, belching,
and bloating. Occasionally, acute abdominal pain can
be a presenting
symptom. Fever, chills, and hiccups also may be present.
• The diagnosis of acute gastritis may be suspected from the
patient's history and can be confirmed histologically by
biopsy specimens

24. • Acute gastritis has a number of causes, including
certain drugs; alcohol; bacterial, viral, and
fungal infections; acute stress (shock); radiation;
allergy and food poisoning; bile;
ischemia; and direct trauma.
Medications used to treat gastritis include:
• Antibiotic medications to kill H. pylori antibiotics
• Medications that block acid production and promote
healing. Proton pump inhibitors (omeprazole)
• Medications to reduce acid